[AMJ 2018;11(11):519-521]

Complicated giant perianal condylomata accuminata transforming into

squamous cell carcinoma in a patient with latent syphilis: Case report and
literature review
Redha Al-Lawati1, Ibrahim Al-Busaidi2
1. Internal Medicine Residency Program, Oman Medical Specialty Program, Oman
2. Department of Medicine, Infectious Diseases Unit, Sultan Qaboos University Hospital, Muscat, Oman

rapidly enlarging perianal mass and progressively invasive

CASE STUDY disease.

Please cite this paper as: Al-Lawati R, Al-Busaidi I. Key Words

Complicated giant perianal condylomata accuminata
transforming into squamous cell carcinoma in a patient with
latent syphilis: Case report and literature review. AMJ
2018;11(11):519–521.
https://doi.org/10.21767/AMJ.2018.3527
Corresponding Author:
Redha Al-Lawati
Internal Medicine Residency Program, Oman Medical
Specialty Program, Oman
Email: allawati_143@hotmail.com
ABSTRACT
Condylomata accuminata, syphilis, sexual behaviours,
infectious diseases, squamous cell carcinoma
Implications for Practice:
1. What is known about this subject?
Giant condylomata accuminata is associated with syphilis
and its very aggressive tumour that may transform to
malignancy rapidly.
2. What new information is offered in this case study?
A different presentation of giant condylomata accuminata in
syphilis patients, they may present with multiple and
recurrent resistant infections and requiring massive blood
transfusion.

Giant condylomata accuminata (CA) is a pre-malignant
tumour, which commonly involves the genital area. Human
papilloma virus (HPV) 6 and 11 are the most common
causative pathogens for this rapidly growing tumour. (CA)
has been also associated with human immunodeficiency
virus (HIV) infection, 40 to 60 per cent of benign (CA)
transforms to malignancy. The main risk factors for HPV
infection and subsequently condylomata include risky
sexual behaviours, early pregnancy and tobacco use.
Here, we report a 55-year-old man who presented with
complicated giant perianal (CA) that transformed into
squamous cell carcinoma. His condition was complicated by
3. What are the implications for research, policy, or
practice?
Syphilis patients should be screened regularly if their
presentation is not usual; resection is the best option for
these kinds of tumours. Imaging should be considered to
look for deep invasion and biopsy to rule out transformation
to SCC.
Background
Giant condylomata accuminata (CA) or the Buschke-
Löwenstein tumour is a pre-malignant tumour, which grows
aggressively in any underlying dermal structure. It is a
recurrent disease and occurs mostly in the genital area.
1

recurrent infections and massive bleeding. The patient
underwent end colostomy followed by surgical resection of
the mass followed by palliative radiotherapy.
Histopathological analysis of the resected mass confirmed
transformation into squamous cell carcinoma. Malignant
transformation of (CA) should be suspected in patients with
Human papilloma virus (HPV) 6 and 11 are the most
2
common causative pathogens for this tumor. (CA) has been
3
also associated with HIV infection. Forty to sixty per cent of
4
benign (CA) transforms to malignancy. The main risk
factors for HPV infection and subsequently condylomata
include risky sexual behaviours, such as multiple sexual

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partners, history of sexual transmitted diseases, early
5 7,8
pregnancy and tobacco use. Here, we report a 55 years old
man who presented with complicated giant perianal CA that
transformed into Squamous cell carcinoma.
Case Details
Our patient is a 55-years-old man who is known to have
diabetes mellitus. He presented to the emergency
department initially with fever and painful perianal mass
associated with bloody and purulent discharge. Examination
under general anaesthesia was performed and it showed:
large irregular and nodular cauliflower hard mass around
the anal verge (Figure 1). Multiple biopsies were taken and
biopsy showed condyloma acuminatum. HPV stains were
negative. HIV screen was negative.
Tissue biopsy had polymicrobial growth including
streptococcus anginsus, streptococcus mitis, anaerobe and
E. coli. Patient received a course of pipercillin/Tazoobactam
for polymicrobial infection of the perianal mass and he
responded well to therapy. Patient had a positive syphilis
test (CLIA positive, TPHA positive, RPR negative) consistent
with late latent syphilis. He received three doses of 2.4
million units of intramuscular benzathine penicillin. Human
immunodeficiency virus screen was negative.
Patient lost follow up then he presented again with
recurrent symptoms and increased perianal mass and he
received antibiotic therapy for infected mass. Pelvic CT
showed large inflammatory perianal mass (Figure 2). During
admission, he developed multi-drug resistant acinetobacter
bacteraemia and sepsis and bleeding requiring multiple
blood transfusions. Given his recurrent infections, persistent
bleeding and invasive nature of the swelling, patient
underwent two stages surgeries. First he underwent loop
colostomy to control infected mass site. Then patient
underwent excision of the tumour with drainage of
abscesses and debridement of the necrotic tissue. The mass
was infiltrating into the anal sphincter and perineal muscles.
Histopathology of the resected mass revealed well-
differentiated squamous cell carcinoma. The patient had
local palliative radiotherapy after surgery. Few days after
the surgery, the patient passed away after becoming
hypotensive and then asystole.
Discussion
Anal condylomata accuminata (CA) has been increasingly
reported in men who have sex with men. In addition,
incidence of anal cancer has increased in homosexual men
and in some reports it is more prevalent than cervical
5
cancer in women. Like in our patient, most patients present
6
late with serious complications. Bleeding due to rich
vascular supply can be difficult to control. Tumour
infection presenting as foul smelling discharge as a common
9
complication of (CA) had been described in the literature.
Our patient’s main presentation was recurrent infections
due to multiple fistulae with rectum and faecal
incontinence. First two biopsies of the mass revealed CA but
histopathology of the surgical specimen confirmed
transformation into squamous cell carcinoma (SCC).
1,2
Malignant transformation of CA have been reported, and
the rate of malignant transformation increased from 12.5
6
per cent in 1960 to 75 per cent in 1980. SCC as a primary
lesion or as a complication of another lesion should be
4
suspected in the right clinical context.
Management of CA involves different modalities depending
on the size and characteristics of the lesion. For small
lesions cryosurgery and topical application of 25–30 per
cent podophyllin or trichloroacetic acid has been used,
however the failure rate reaches up to 25 per cent. For large
size lesions, interferon therapy or chemotherapy has been
used to shrink the size of the tumour prior to surgical
excision. Surgical excision in considered the first line
therapy for large tumour. Different methods of surgery
were discussed in the literature; radical local excision or by
electro surgery using electrocoagulation for example or by
6,8,9
both methods. Our patient had two stages surgery, the
first one was for loop colostomy, to divert the faecal
content from the tumour, and the second one was for local
excision of the tumour. After the final histopathology results
and diagnosis of locally advanced SCC, approach was revised
and he received palliative radiation therapy. Given his
locally advanced disease and high surgical risk, palliative
radiation therapy was advised with regular follow up and
10
supportive care.
Conclusion
Perianal Condylomata accuminata is a pre-malignant
tumour caused by sexually transmitted human papilloma
virus (11 and 16). Giant lesions can be complicated by
fistulisation, recurrent infections and bleeding.
Transformation into squamous cell carcinoma is possible
and it should be always suspected in patients with rapidly
enlarging mass and progressively invasive disease.
References
1. Suárez-Ibarrola R, Heinze A, Sánchez-Sagástegui F, et al.
Giant Condyloma Acuminatum in the Genital, Perineal
and Perianal Region in a Pediatric Patient. Literature
Review and Case Report. Urol Case Rep. 2016;7:14–16.
2. Papiu HS, Dumnici A, Olariu T, et al. Perianal giant
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condyloma acuminatum (Buschke-Löwenstein tumor). Figure 1: Large invasive mass lesion in the anal verge with
Case report and review of the literature. Chirurgia. multiple fistulae
2011;106:535–539.
3. Kreuter A, Potthoff A, Brockmeyer NH, et al. Anal
carcinoma in human immunodeficiency virus-positive
men: results of a prospective study from Germany. Br J
Dermatol. 2010;162(6):1269–77.
4. Hicheri J, Jaber K, Dhaoui MR, et al. Giant condyloma
(Buschke-Löwenstein tumor). A case report. Acta
Dermatovenerol Alp Panonica Adriat. 2006;15(4):181–3.
5. Leszczyszyn J, Łebski I, Łysenko L, et al. Anal Warts
(Condylomata Acuminata) – Current Issues and
Treatment Modalities. Adv Clin Exp Med.
2014;23(2):307–311. Figure 2: CT Pelvis: Large invasive perianal mass
6. Safi F, Bekdache O, Al-Salam S, et al. Management of
peri-anal giant condyloma acuminatum. A case report
and literature review. Asian J Surg. 2013;36:43–52.
7. Yakasai IA, Abubakar IS, Ibrahim SA, et al. Unusual
presentation of giant condylomata acuminata of the
vulva: A case report and review of literature. Ann Trop
Med Public Health. 2012;5(5):508–510.
8. Chang GJ, Welton ML. Human Papillomavirus,
Condylomata Acuminata, and Anal Neoplasia. Clin Colon
Rectal Surg. 2004;17(4):221–230.
9. Badiu DC, Manea CA, Mandu M, et al. Giant Perineal
Condyloma Acuminatum (Buschke-Löwenstein Tumour):
A Case Report. Chirurgia. 2016;111:435–438.
10. De Toma G, Cavallaro G, Bitonti A, et al. Surgical
Management of Perianal Giant Condyloma Acuminatum
(Buschke-Löwenstein Tumor). Eur Surg Res
2006;38:418–422.

PEER REVIEW
Not commissioned. Externally peer reviewed.

CONFLICTS OF INTEREST
The authors declare that they have no competing interests.

FUNDING
None

PATIENT CONSENT
The authors, Al Lawati R, Al-Busaidi I, declare that:
1. They have obtained verbal, informed consent for
the publication of the details relating to the
patient(s) in this report.
2. All possible steps have been taken to safeguard the
identity of the patient(s).
3. This submission is compliant with the requirements
of local research ethics committees.

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